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Pharm Year 3 Sem1 patient > joint disease > Flashcards

joint disease Flashcards

1
Q

aetiology of rheumatoid arthritis

A

unknown

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2
Q

pathogenesis of rheumatoid arthritis

A

lymphocytes infiltrate synovial membrane
causing inflammation and thickening
formation of pannus over cartilage causing erosion into bone
eventual degeneration of cartilage and joint

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3
Q

treatment of Rheumatoid arthritis

A 
analgesics
NSAIDS
conventional DMARDS
biological DMARDS
Steroids
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4
Q

describe a fibrous joint

A

The bones of fibrous joints are held together by fibrous connective tissue. There is no cavity, or space, present between the bones, so most fibrous joints do not move at all.

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5
Q

Describe a Cartilaginous joint

A

Cartilaginous joints are those in which the bones are connected by cartilage.

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6
Q

aetiology of osteoarthritis

A

unknown

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7
Q

pathophysiology of osteoarthritis

A 
cartilage roughens and becomes thin
thickening of underlying bone
formation of osteophytes (bone growth)
thickening and inflammation of synovium
thickening and contraction of ligament
fluid may appear from inflammation
bones come closer
some joints repair themselves
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8
Q

goals in management of osteoarthritis

A 
reduce pain 
 optimise mobility
minimise joint deformity
patient education
MDT approach
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9
Q

define osteoporosis

A

generalized skeletal disorder of low bone mass (thinning of the bone) and deterioration in its architecture, causing susceptibility to fracture. t score = 2.5

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10
Q

define Rheumatoid arthritis (RA)

A

autoimmune inflammatory disorder that primarily affects the synovial joints of the hands, feet, and cervical spine.
affects 30-50 mainly, females
juvenile arthritis affects

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11
Q

pathogenesis of

A 
trabecular bone (inner meshwork of bone) becomes v holey due to decreased osteoblast activity and increased osteoclast activity
results in a low peak bone mass
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12
Q

when does peak bone mass occur?

A

25-40

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13
Q

risk factors for osteoporosis

A

women
taking high-dose steroid tablets for more than 3 months
inflammatory conditions, hormone-related conditions, or malabsorption problems
a family history
long-term use of certain medicines that can affect bone strength or hormone levels, such as anti-oestrogen tablets that many women take after breast cancer
having or having had an eating disorder such as anorexia or bulimia
having a low BMI
not exercising regularly
heavy drinking and smoking

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14
Q

pathogenesis of

A 
trabecular bone (inner meshwork of bone) becomes v holey/spongey due to decreased osteoblast activity and increased osteoclast activity
results in a low peak bone mass
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15
Q

when does peak bone mass occur? how much does it decrease yearly after this?

A

25-40

1% each yr

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16
Q

risk factors for osteoporosis

A

women
taking high-dose steroid tablets for more than 3 months
inflammatory conditions, hormone-related conditions, or malabsorption problems
a family history
long-term use of certain medicines that can affect bone strength or hormone levels, such as anti-oestrogen tablets that many women take after breast cancer
eating disorder such as anorexia or bulimia
having a low BMI
prednisolone use
white people
RA, IBD, kidney and liver disease
calcium intake
risk of recurrent falls
not exercising regularly
heavy drinking and smoking

17
Q

what is a DXA scan ?

A

looks at some bone density
compares to normal density for age and calculate a score

v expensive

18
Q

signs and symptoms of osteoporosis

A 
fracture
reduced bone density on DXA scan
pain
reduced mobility
kyphosis - in vertebral fractures
reduction in height
19
Q

pathogenesis of osteoporosis

A 
trabecular bone (inner meshwork of bone) becomes v holey/spongey due to decreased osteoblast activity and increased osteoclast activity
results in a low peak bone mass
20
Q

how does bone mass change over the years

A

peak at 25 - 40 year
loss at 0.5-1% a year
men have higher bone density
stages: attainment of peak,consolidation and age relates bone loss

21
Q

what is a DXA scan ?

A

looks at some bone density
compares to normal density for age and calculate a score
(T score)
v expensive

22
Q

how do vertebral fractures affect patients?

A

results in height reduction 10-20 cm
often under diagnosed
can cause problems with indigestion neck weakness, back pain, loss of mobility

23
Q

how does bone mass change over the years?

A

peak at 25 - 40 year
loss at 0.5-1% a year
men have higher bone density
stages: attainment of peak, consolidation and age relates bone loss
women have accelerated loss after menopause due to loss o oestrogen protective effect

24
Q

primary management of osteoporosis

A 
lifestyle: 
adequate Ca and Vit D 
weight bearing exercise
reduced alcohol intake
stop smoking
reducing fall risk
25
Q

secondary prevention for osteoporosis

A 
pharmacological: 
calcium
vit D
Calcitriol
HRT
SERMS
Bisphosphonates
Calcitonin
Strontium
PTH
Denosumab
in addition to lifestyle changes
26
Q

define osteoarthritis
clinical features?
who does it effect?

A 
limited to 1-2 joints(knee, hands, lumbar and cervical spine)
may be accompanied
 caused by stress on joints
wear and tear
obesity increases risk
heavy manual work
affects over 65s mainly 
onset 40-60%
Early morning Stiffness (EMS , 30 mins)
27
Q

non pharmacological management of osteoarthritis

A 
weight reduction
physiotherapy
exercise plan
heat packs
occupational therapy
psychological support
surgery
28
Q

pharmacological management of osteoarthritis

A

simple analgesics - paracetamol, codeine
NSAIDs
Corticosteroids
Chondoprotective agents - glucosamine sulfate

29
Q

clinical features of RA

A

slow progressive symmetrical polyarythritis (lots of joints affected)
pain and stiffness in small joints of hands and feet
involvement of wrists, shoulders, elbows,knees and ankles
Early morning stiffness - stiffness gets worse
pain improves in day

30
Q

extra- articular (outside joint) symptoms of Rheumatoid arthritis

A

Sjorgen’s syndrome (dryness of eye and mouth)
vasculitis ( inflammatory condono of vessels
neuropathy
subcutaneous nodules (painful tissue over joint)
lymphadenopathy ( chronic autoimmune disease)
CVD
depression
Respiratory disease
osteoporosis

31
Q

how many patients have sever rheumatoid arthritis

A

5%

32
Q

how many patients have severe rheumatoid arthritis?

A

5%

33
Q

goals of RA management

A 
relief of pain and inflammation
prevention of joint damage
preservation/improvement of functional ability
maintain of lifestyle
MDT approach
34
Q

describe the differences between OA and RA

A 
OA:
 restricted to joints
occasional warm, tender,swollen joints
?raised inflammatory markers
rarely severe joint deformities
affects 50 years onwards
RA: 
systemic disease
multiple joint involvement 
usually warm tender, swollen joints
raised inflammatory markers
often joint deformities
many extra articular symptoms 
affects any age

Pharm Year 3 Sem1 patient (12 decks)

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